Provider Demographics
NPI:1497709802
Name:HOSPICE ADVANTAGE, LLC
Entity Type:Organization
Organization Name:HOSPICE ADVANTAGE, LLC
Other - Org Name:HOSPICE ADVANTAGE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:300 CHASTAIN CENTER BLVD
Practice Address - Street 2:SUITE 345
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5557
Practice Address - Country:US
Practice Address - Phone:770-218-1997
Practice Address - Fax:770-218-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-234-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA622834679AMedicaid
GA51864050OtherBLUE CROSS OF GEORGIA
GA51864050OtherBLUE CROSS OF GEORGIA